SCOTT BARKOWSKI

Profile Photo
Assistant Professor
John E. Walker Department of Economics
Clemson University

Faculty Scholar
School of Health Research
Clemson University

sbarkow {at} clemson {dot} edu

Curriculum Vitae

Fields of research interest
  • Health economics
  • Labor economics
  • Econometrics
  • Industrial Organization


    Working Papers


    The Effect of Specialist Cost Information on Primary Care Physician Referral Patterns
    • Contact me for early draft
    ABSTRACT: I examine the importance of cost information in the physician referral process. I partner with a group of physician medical practices -- an Independent Practice Association (``the IPA'') -- to perform a field experiment testing whether providing information on the costliness of specialist physicians to primary care physicians (PCPs) alters the PCPs' referral behavior. The IPA's primary care practices were assigned randomly to treatment or control groups, and the treatment group practices were provided a list of average costs for several ophthalmologists that are affiliated with the IPA. Using data collected by the IPA, I compare differences in referral rates to the ophthalmologists of interest between the treatment and control groups. My results suggest that, during the first two months following the distribution of the cost list, the treatment group PCPs reallocated referrals towards the least expensive ophthalmology practice by 112% when the patients were the type where the costs incurred by the IPA for the referral depend on the treatment choices of the specialist. This large effect dissipated significantly, though not completely, over the following four months. For patients where specialist treatment choices have little impact on the costs the IPA incurs for referrals, I find no response to the treatment. This contrast in results suggests that PCP responses were influenced by cost reduction motives.


    Does Government Health Insurance Reduce Job Lock and Job Push? (Under Review)
    ABSTRACT: I study job lock and job push, the twin phenomena believed to be caused by employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers as a proxy for shifts in workers’ dependence on employment for health insurance, I estimate large job lock and job push effects. For married workers, Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit over a four-month period by approximately 34%. For job push, the transition rate into jobs with ECHI among all workers falls on average by 26%.


    Does Regulation of Physicians Reduce Health Care Spending? (Revise & Resubmit)
    ABSTRACT: The medical community often argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous empirical work, however, has ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that health care spending does not rise in response to higher levels of risk. An increase in adverse actions equal to 16 (the mean, absolute value of year-to-year changes within a state) is found to be associated with statistically significant average annual spending decreases in hospital care and prescription drugs of as much as 0.25% (nearly $29 million) and 0.29% (almost $9.3 million). Malpractice payments were generally estimated to have smaller, statistically insignificant effects.


    Publication


    Does employer-provided health insurance constrain labor supply adjustments to health shocks? New evidence on women diagnosed with breast cancer
    ABSTRACT: Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse’s employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11 percent smaller. Women’s subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior.